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Diabetic Foot Infection - Causes and Treatment

Diabetic Foot Infection - Causes and Treatment

Diabetes Mellitus is a disease that is caused by dysregulation of the glucose metabolism of the body, leading to high blood sugar levels. India is known to be the Diabetic capital of the world with over 70 million diagnosed cases.

What is Diabetic foot condition?
Diabetes Mellitus is a disease that is caused by dysregulation of the glucose metabolism of the body, leading to high blood sugar levels. India is known to be the Diabetic capital of the world with over 70 million diagnosed cases. Diabetes is a systemic disease that affects the entire body. The foot frequently gets involved in diabetic patients and problems can spread to the entire lower limb if left untreated, this condition is called Diabetic Foot. In fact, there are studies that indicate that loss of the foot or leg in a diabetic patient is a predictor for mortality in these patients.

What causes Diabetic foot?
The lower limb and foot gets affected in diabetes due to many reasons. 
Blockage of leg artery: The arteries of the leg may get blocked leading to the reduced blood supply to the part. The nerves get affected leading to loss of protective sensation to the foot. 
Reduced immune response and/or deformities: High blood sugar levels cause a poor immune response to infections. The bones and soft tissues change their shape and become stiff leading to deformities in the foot. Reduced sensation and deformities lead to unintentional injuries of the foot which may lead to wounds on the foot. These get easily infected because of high sugars and poor immune system. Minor infections of the nails or toes can rapidly spread fast and lead to cellulitis and skin death. Further complications can cause diabetic feet swelling, or gangrene (death) of the foot or leg and can cause serious danger to the life of the patient.

How to keep the diabetic foot condition under check?
In order to avoid loss of limb and life due to diabetic foot problems, one has to be aware of these issues and address them at the right time. It is ideal to treat diabetic patients at a centre which has a multi-disciplinary team that handles all problems associated with Diabetes. Specifically, regarding the foot, periodical evaluations are essential by a trained doctor to look for sensations, blood flow, deformities, calluses and small ulcers. At a very early stage itself, offloading of pressure bearing areas of the foot should be done with appropriate footwear. Self-care of the foot should be advised.

What are the medical treatments of diabetic foot?
It is necessary to detect deformities in the early stage and correct them before they cause problems. Plastic surgeons can help in the release of compressed nerves to improve the sensations of the foot. Corrective surgeries for soft tissue deformities may also be done. The blood flow to the foot can be improved by various surgical or non-surgical procedures. The role of the foot orthopaedic surgeon is also important to correct bony deformities and to fuse damaged joints in order to achieve a stable architecture of the foot.
In the case of ulcers of the foot, all of the above measures have to be taken to correct the underlying causes for ulceration. Surgical and nonsurgical debridement or cleaning is essential to achieve a healthy wound. Adjuvants like Negative Pressure Wound Therapy and hyperbaric oxygen therapy are also helpful in this regard. Many ulcers will heal with correction of the underlying cause, appropriate footwear and good wound care. Others may need reconstructive surgeries in the form of skin grafting, local flaps or micro-vascular flaps to achieve healing of the wound. A good plastic surgical team can provide all these facilities to treat diabetes infected foot and toe.
Continuing care of the foot is essential to prevent further diabetic infection to the foot and to maintain whatever success has been already achieved. Diabetic foot care is thus a complex and specialized field involving many specialities. It is best undertaken at a centre providing all these facilities. With appropriate multi-disciplinary care, limb and life can be salvaged.

Dr. Jose Tharayil
Cosmetic & Plastic Surgeon
VPS  Lakeshore Hospital